traveling claims analyst Resume

Posted on: 2007-06-06

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Resume:

Gina Williams N th Place #, Phoenix, AZ

Objective: To obtain a business oriented position that will utilize my education as well as experience to the fullest potential.

Experience: /-/ Western Research Laboratories Phoenix, AZ
Customer Service Representative\\Office Manager
&#; Principle customer service representative for major accounts.
&#; Responsible for supporting sales growth through potential and existing customers.
&#; Performing entry level customer complaints resolving invoice problems and issue debit and credit issues.
&#; Provide customer information to physicians, wholesalers, distributors, and existing as well potential customers regarding complaints/orders.
&#; Provide basic and FDA standard information to potential customers, licensed physicians as well alternative living patients regarding prescription as well unadvertised natural alternative drug information within the FDA AND UFD guidelines.
&#; Perform price calculation information as well as shipping methods, dates, containers and quantities to existing and potential customers.
&#; Maintain inventory stats on back orders, ingredients, and products.
/-/ Schaller Anderson Phoenix, AZ
Customer Service Representative
&#; Hired as a CICR representative for the Mercy Care Plan where for months received in-bound calls from provider office with inquiries regarding claims payments, prior authorizations, encounter denials, and Coordination of Benefits inquiries.
&#; Assisted research and adjustment departments with the resubmissions and reconsiderations.
&#; Advanced to Analyst III position for the Behavioral Health department assisting with claims processing, along with re-pricing facility and professional claims for the State of Arizona, Harrington and any other accounts within the Behavioral Health Department under HIPPA guidelines.
&#; Primary function to processing research and adjust professional and facility claims for Contact, Behavioral Health, The State of Arizona, and Harrington claims.
/-/ Pinnacle West / APS Phoenix, AZ
Benefits Examiner / Customer Service Representative
&#; Processed medical and claims for both active and retired APS employees under Cigna, United Health Care, and Pinnacle West Guide Lines.
&#; Provided customer service to participating and non-participating providers, as well as employees, and hospitals regarding policy provisions, plan guidelines and any other questions under the HIPPA guidelines.
/-/ PC Group Duluth, GA
Customer Service Representative
&#; Assist agents and customer clients with any questions or quotes regarding auto insurance policies for Texas, California, Georgia, and North Carolina..
&#; Assist the underwriting department with binding auto policies and any corrections required under the law for existing policies.
&#; Back up for the premium, finance customer service department.
&#; Assist the claims, underwriting, premium finance, data entry, and other departments during the conversion period in a call center environment.
/-/ Claim Services Resource Group Dallas, TX
Specialized Benefits Analyst
&#; Traveled to various assignments for client companies to assist in the reduction strategies of lowering backlogs.
&#; Specialized in audits, utilization review, adjustments, adjudication of claims, customer service, pre-certifications, and member services..
&#; Supervised, trained, and was technical lead of employees in the unit.
&#; Assist investigating fraud and abuse of providers and policyholders.

Education: Robert Morris College Pittsburgh, PA
Connelly School of Trade Pittsburgh, PA

Computer Skills: MS Excel MS Word Eldorado RIMMS
Homegrown Software - Many